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학습 자료 둘러보기 →| Option | Analysis and Rationale |
|---|---|
| 1. Administer prescribed oxytocin intravenously | This is an essential pharmacological intervention for uterine atony and is a core component of active management [2][4]. However, it is not the priority initial action. Nursing protocols dictate that non-pharmacological measures, specifically fundal massage and bladder emptying, should be performed first and simultaneously while preparing for oxytocin administration . If the atony is primarily caused by a full bladder, oxytocin alone may be ineffective until the bladder is emptied. |
| 2. Insert a urinary catheter to empty the bladder | This is a critical and necessary intervention for a displaced uterus, as a full bladder is a primary cause of uterine atony that is resistant to massage [4]. However, it is the second priority. The immediate, life-saving action to control bleeding is to manually stimulate uterine contraction via massage. The nurse can delegate the preparation for catheterization or perform it immediately after the initial fundal massage while maintaining uterine tone. |
| 3. Notify the healthcare provider immediately | While communication is vital, especially in a hemorrhage emergency, it does not take priority over direct, hands-on interventions that can immediately control bleeding. The nurse should initiate the first-line interventions of fundal massage and bladder emptying while another team member notifies the provider. Delay in these direct actions can lead to increased blood loss and a higher risk of hypovolemic shock [3]. |
| 4. Perform fundal massage to stimulate uterine contraction | Correct. This is the priority nursing intervention. The immediate goal is to reverse the uterine atony, the direct cause of the hemorrhage. Fundal massage provides the mechanical stimulation needed to trigger a sustained uterine contraction, thereby compressing the open vessels at the placental site [3]. This action directly addresses the "boggy" assessment finding and is the foundational first step in all postpartum hemorrhage protocols before proceeding to address the underlying cause of the displacement [2][4]. |
Assessment Findings: A boggy, soft uterus displaced above the umbilicus suggests uterine atony secondary to a distended bladder. Heavy vaginal bleeding is present.
Priority Intervention - Fundal Massage:
Sequential Protocol if Bleeding Persists:
Key Safety Point: Never massage a uterus that is already firm, as this can disrupt clot formation and increase bleeding. Always support the lower uterine segment to prevent inversion.
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